Diabetes & Your MouthTake steps to protect your feet

If you have diabetes, chances are that you already know your risk of other health conditions is higher. This is true when it comes to your mouth, as you are more likely to get gum (periodontal) disease. What’s more, the risk goes both ways. Severe gum disease can make it harder to control your diabetes. Chronic inflammation from gum disease is linked to many diseases in the human body.

Believe it or not, focusing on better oral hygiene can help keep your diabetes under control. Brushing, flossing, and visiting the dentist for regular cleaning and check-ups can all make a difference.

Your mouth may already be signalling that you are developing diabetes. Some warning signs include:

dry mouth (xerostomia)

fungal infection (candida infections)

burning of the tongue

and increasingly serious gum disease.

In xerostomia, a declining amount of saliva makes your mouth dry. This complaint is common in people whose diabetes may not be under the best possible control. It can come from dehydration, from medications taken for heart disease (a complication of diabetes), or both. If your mouth is constantly dry, you are higher risk of candidiasis, ulcers, sores and tooth decay. Candidiasis, or thrush, is an infection of the mouth. It often appears as white plaque or patches forming on the inside of the cheeks or on the tongue. Sometimes it is painful. Thrush should be diagnosed by your doctor or dentist.

The nerves in your mouth can also be damaged by diabetes, a condition called diabetic neuropathy. A burning mouth or tongue, loss of or changes in taste can all signal nerve damage. The best way to prevent neuropathy is by keeping blood glucose levels tightly controlled in the target goal range.

Periodontal (gum) disease

As many as three billion bacteria live in your mouth. Some are harmful, while others are beneficial. A balanced bacterial composition is critical to preventing inflammation and gum disease. Good oral hygiene can help keep bacteria in check. First, brush and floss with care. As well, schedule regular dental cleanings every six months to remove plaque (food debris and bacteria). Those with periodontal disease may need dental cleanings every three to four months. Cleanings help to remove harmful calculus (calcified plaque), reducing inflammation and damage.

Since having diabetes means wounds heal more slowly, gum disease is often more frequent and severe in those with diabetes. Periodontal disease and diabetes actually feed off one another, making both conditions worse. Both conditions encourage inflammation throughout the body. This increases the risk of other inflammatory diseases like stroke, heart disease, kidney disease, and arthritis. For this reason, controlling blood glucose levels and keeping the teeth clean is critical.

The gums and bone around the teeth act as protective barriers against mouth bacteria. In gum disease, this barrier is weakened. More bacteria from the mouth enter the body via the blood stream. Blood vessels and other tissues in the body become inflamed.

The early stage of gum disease is called gingivitis. Plaque made of bacteria and food debris collects around the teeth and gums. If plaque is not brushed and flossed away regularly, gums become red, swollen, and inflamed. The most noticeable sign is that the gums bleed easily. The good news is that once you start caring for your teeth properly, gingivitis is completely reversible. Good control of blood glucose levels helps gums and supporting tissue around the teeth to heal properly.

Left unchecked, gingivitis can progress to a more serious condition. Plaque left for long periods of time will calcify into calculus. At this point, a dental professional must remove it with a scaling instrument. If plaque is not removed, gums and bone supporting the teeth begin to break down as periodontitis develops.

Periodontal disease is among the most common chronic diseases in humans, affecting 65 per cent of adults). It is caused by a bacterial infection. Periodontal disease is linked to a higher risk of heart disease, having a stroke, or if you are pregnant, bearing a low birth-weight baby. It also poses a serious problem for people with diabetes, osteoporosis or respiratory diseases like COPD. Serious dental infections, such as abscesses, can make it more difficult to control blood glucose levels.

If you think dental problems may be making it hard for you to manage your blood glucose levels, talk to your doctor or diabetes educator.
Avoiding issues with your mouth

The first step in avoiding issues with your mouth is to keep your blood glucose levels under control. People with diabetes who manage their blood glucose levels within target ranges have no greater risk for developing gum disease than people without diabetes.

Having high blood glucose levels does increase your chances of developing severe gum disease. Periodontitis is more common and more severe when combined with high blood glucose.

Maintaining your best mouth health

Toothbrush:
Toothbrush bristles should be soft or extra soft (never medium or hard). Electric toothbrushes are a good choice.

Toothpaste:
Using a toothpaste with fluoride is recommended. If you have sensitive teeth, choose a toothpaste that is specially made for this problem. Also, avoid whitening or tartar control toothpastes since these may make your teeth even more sensitive.

Flossing:

Daily flossing is very important. Flossing your teeth ensures that you are cleaning areas that are not cleaned by brushing alone. It is important to floss each contact area: bring the floss down to the base of the gums while maintaining firm but gentle pressure along the side of each tooth. The floss should form a C shape around the side of the tooth. Use an up-and-down motion until you hear a squeak as the floss passes along the tooth surface. This tells you that the tooth is clean.

Rinses:
A mouth rinse containing fluoride is recommended for people who are prone to tooth decay along the gumline. Remember to avoid rinses that have a high alcohol content, since they tend to leave the mouth dry.

At least twice a day, brush your teeth with a soft or ultra-soft bristled toothbrush.

Floss at least once a day.

Schedule regular dental visits for cleaning and check-ups.

The condition of your gums will indicate how often professional cleaning is needed. Generally, healthy gums and teeth should be checked and cleaned every six to nine months. If you have gum disease or poor oral hygiene habits, book a cleaning every three to four months. Your dental technician will clean plaque and calculus away from the gum pocket using scaling and root planing.

Regular cleanings reduce inflammation in the gums, strengthening the protective barrier against mouth bacteria entering the body. The hope is to avoid the gum surgery and antibiotics sometimes required by advanced gum disease. Treating periodontal disease is always an ongoing process. Even if gum disease has halted, continuous maintenance is needed to keep it from coming back.

Be sure to tell your dentist about your diabetes. Schedule your appointments in the morning, as your body is best able to handle stress at this time. Short appointments are easiest. Before your appointment, follow your regular diabetes schedule and take your insulin. Never skip breakfast!

If you feel faint or weak during the treatment, tell your dentist or hygienist. If your dental health changes dramatically, your dentist may recommend meeting with your family doctor to discuss your diabetes management.

If you do need surgery, be aware that slow healing of wounds in common in diabetes. For this reason, people with diabetes must be watched closely after any dental surgery. Extractions (tooth removal), scaling, implant placement, and gum surgery may also require extra care such as antibiotics.

Developing excellent oral hygiene habits can begin today. Remember, when your diabetes is well controlled and you are taking good care of your mouth, you will have no greater risk of periodontal disease than anyone else.